Correlation Of CD4 Count Research Articles

IJCM_425A: Outcomes of Second Line Anti-Retroviral Therapy Among a cohort of people living with HIV/AIDS attending an ART Centre in Mangalore

Background: Anti-Retroviral therapy for HIV/AIDS has been effective, but the mortality rate remains to be high, resulting in the use of second line of ART treatment for better results. Objectives: 1) To estimate the number of deaths among PLHIV between the years 2011 and 2017. 2) To assess the clinical immunological and virological outcomes among these patients. 3) To find out the association of outcomes with the socio demographic characteristics. Methods: In this record-based study, medical records of PLHIV seeking treatment from an ART center associated with KMC, Attavar. between the years 2011 and 2017 were reviewed. The data was extracted using a data extraction sheet consisting of sections on demographic, clinical and treatment details of the patient. Results: The baseline median CD4 count before starting ARTs was found to be 253 (IQR 150-351). After starting second line ARTs it was found to be 461 (IQR 326-651). The correlation of CD4 count after initiation of second line ART with viral load among 34 patients measured was found to be -0.371 (P<0.05). Conclusion: The study concludes that the outcomes of second line ARTs in the present study were found to be satisfactory. The average CD4 count after the initiation of ARTs was significantly high as compared to the CD4 count before the ARTs, implying that second line ARTs had a good, long-term and positive immunological outcome on PLHIV and attending a second-line ART clinic.

Understanding the Interplay: A Comprehensive Literature Review on the Correlation of CD4 Counts with Ocular Manifestations in HIV

Understanding the Interplay: A Comprehensive Literature Review on the Correlation of CD4 Counts with Ocular Manifestations in HIV

Comparative study of ocular manifestations of HIV infection at a tertiary care hospital in Maharashtra, India

Purpose: We conducted the study to observe the change in infection patterns with the introduction of highly active antiretroviral therapy (HAART) and correlation of CD4 count with various ocular manifestations of acquired immune deficiency syndrome (AIDS).
 Design: This was a prospective observational cohort study.
 Methods: The study was conducted at a tertiary care teaching institute with established antiretroviral therapy (ART) centre. A total of 240 eyes of 120 ART-naive patients were enrolled. Ocular manifestations of these patients were observed and followed up for six months for any change with HAART.
 Results: Out of 240 eyes, 24 showed ocular involvement (10%), of which human immunodeficiency virus (HIV) microangiopathy and molluscum contagiosum were most common. Out of the four cases of HIV microangiopathy, two cases demonstrated complete resolution after six months of ART. Only one of three cases of cytomegalovirus (CMV) retinitis showed healing after six months of ART.
 Conclusions: Vision-threatening CMV retinitis and herpes zoster ophthalmicus can improve if specific treatment is initiated promptly. There is direct correlation between CD4 count, ocular manifestation, and prognosis of the patients; 33.33% of patients showed improvement in ophthalmic manifestations after HAART during a follow-up period of 6 months.

Correlation of CD4 counts with oral and systemic manifestations in HIV patients.

Aim:Aim of the study was to correlate CD4 counts with oral and systemic manifestations in HIV patients.Materials and Methods:Study population comprised of newly diagnosed 100 confirmed seropositive patients, before starting any antiretroviral therapy, were included. The oral lesions were diagnosed based on clinical manifestation using international criteria and CD4 count was determined within maximum 1 week of oral examination. Oral and systemic manifestations of HIV-positive patients were recorded and correlated with CD4 counts.Results:It was found that decrease in CD4 count is associated with a wide range of oral and systemic manifestations which can be used as prognostic marker for immune suppression in AIDS patient.Conclusion:Correlation of CD4 count with oral and systemic manifestation in HIV patient demonstrate the role of oral physician in identification, diagnosis, and treatment of HIV-associated lesions, providing proper guidance to the patient and allowing for an early diagnosis and treatment of the disease, which is fundamental for a successful management of the life conditions of HIV infected patients.

Clinical Correlates of Hepatitis B or Hepatitis C Coinfections in People Living with HIV/AIDS (PLHIV)

Introduction: Hepatitis B virus (HBV) coinfected HIV patients are likely to have chronic hepatitis B infection and associated severe liver disease, however effect of hepatitis B on HIV has not been proven to be off any effect. Similarly in HIV/HCV co-infection majority of the studies have shown no significant influence of hepatitis C on the course of HIV infection, although some studies have demonstrated an association between HCV infection and faster HIV disease progression.14,15 Therefore, further studies are needed to study the impact of HBV/HCV co-infection on course of HIV, specially, in India. Aims and Objectives: To study the clinical, biochemical and immunological profile of PLHIV co-infected with either hepatitis B or hepatitis C virus, the severity of liver disease and hepatitis B and hepatitis C viral loads in these co-infected PLHIV and the association of WHO stage of HIV and immunosuppression with hepatitis B and hepatitis C viral loads as well as severity of liver disease. Method: It was an observational cross-sectional study, involving 30 PLHIV co-infected with either hepatitis B or C. A detailed history and physical examination was done. Complete Haemogram, Liver function tests, kidney function tests, Ultrasonography abdomen, CD4 cell counts, hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), hepatitis B Viral DNA (HBV DNA) and HCV RNA levels were done. Severity of liver disease was assessed by FIB 4 SCORE. Results: Among the 30 PLHIV subjects 30% were co-infected with HCV 70% were co-infected with HBV (HBsAg positive). All the subjects were asymptomatic for their liver disease. All the subjects were on Anti-Retroviral Therapy (ART) and 80% were in Early WHO stage (T1 and T2) and 20% were in Advanced WHO stage (T3 and T4). It was similar in both HBV and HCV co-infected group. The mean CD4 count of the subjects was 416.70±189.50 cells/mm3 with the range of 69 – 909 cells/mm3. Five subjects (16.67%) had a CD4 count 3.25). In HCV co-infected subjects 3 of 9 (33.33%) had severe liver fibrosis and only 1 of 21 (4.7%) among HBV co-infected had severe liver fibrosis.Among the 9 HCV co-infected subjects, 3 (33.33%) had undetectable HCV RNA. More number of subjects with detectable hepatitis C viral load had severe liver disease as compared to undetectable viral load.In HIV and HBV co-infected subjects the HBeAg positivity was seen in 42.86% subjects and 38.1% subjects had detectable HBV DNA load. Significant correlation was seen between HBeAg positivity and HBV DNA load. No correlation could be found between FIB 4 score and hepatitis B envelope antigen (HBeAg) positivity or HBV DNA load.No correlation between severity of liver disease (FIB 4) score and WHO staging or CD4 count could be seen. WHO staging and CD4 count also did not correlated with HCV RNA load, HBeAg positivity and HBV DNA load. Conclusions: There is no correlation of CD4 count and WHO stage with liver disease severity or hepatitis viral load in patients on HAART. In HIV and HBV co-infected patients high prevalence of HBeAg positivity is seen. Thus it becomes important to look for deranged liver enzymes and HBeAg positivity in PLHIV coinfected with hepatitis B so that ART can be initiated in these patients irrespective of CD4 count. Hepatitis C co-infected subjects are more likely to have severe liver disease inspite of good CD4 count, so specific treatment for hepatitis C virus should be considered.

Study of cardiovascular manifestations in patients of HIV- its correlation with CD4 count and the ART regimen prescribed

Background: In patients of HIV, there is correlation of CD4 count with severity of cardiac involvement. Some HAART regimens are associated with increased risk for cardiovascular events. This study was undertaken to detect occurrence of symptomatic or asymptomatic cardiac involvement in HIV/AIDS cases. Correlation with CD4+Tcell count and the ART regimen prescribed was also studied. Methods: This single point cross sectional case control study of 103 patients with HIV infection on HAART therapy was studied from April 2014 to August 2015. The study population was investigated for routine blood tests, X-Ray chest PA view, ECG, CD4 count and 2D transthoracic echocardiography. Results: The cases comprised of 43 females (41.75%) and 60 males (62.0%). Mean CD4 count was 205.48±150.06/µL and on X-ray chest PA view cardiomegaly was found in 40.78% of cases. The ECG findings were sinus tachycardia (19.42%), left axis deviation (5.82%), low voltage complexes (16.5%), right axis deviation (16.5%) intraventricular conduction delay (5.82%) and ST-T changes (8.7%) The echocardiographic findings were left ventricular diastolic dysfunction (60.24%), pericardial effusion (15.53%), dilated cardiomyopathy (23.03%), pulmonary artery hypertension (17.47%) and valvular lesions (33%). Conclusions: Declining CD4 count was associated with increased cardiac manifestations but no statistically significant difference was found in both the (TLE and ZLN) subgroups.

Evaluation of total lymphocyte count (TLC) as a surrogate marker for CD4 count in HIV-positive patients for resource-limited settings

Context: The immunity in HIV-infected patients becomes low due to involvement of CD4 cells. The single best predictor of AIDS onset identified is the percentage or absolute number of circulating CD4+ T cells. However, providences in resource-constraint settings may not have access to this laboratory measurement, or its cost may be prohibitive resulting in the need for an alternative, surrogate marker. Hence, total lymphocyte count (TLC) was evaluated as a probable surrogate marker for CD4 count in this study. Aims: To evaluate the correlation of CD4 counts with the TLC for predicting the progression of HIV infection, and to determine a range of TLC cut-offs for predicting CD4 count <200 cells/μl, which is important for the initiation of antiretroviral therapy (ART) and opportunistic infection (OI) prophylaxis. Settings and Design: This study was conducted in the Department of Microbiology at Government Medical College, Aurangabad. Materials and Methods: A total of 250 HIV-positive patients were included in the study. Their Complete Blood count and CD4 count were measured and the TLC was computed. Statistical Analysis Used: SPSS software version 10.0. Results: A positive correlation between TLC and CD4 count was observed in our study, highlighting the role of this surrogate marker in resource-limited settings. Further, a TLC cut-off of ≤1700 cells/μl was found to be the best predictor for a CD4 count <200 cells/μl. Conclusions: A general correlation between the surrogate marker TLC and expensive CD4 counts could be elicited for the population under study. A TLC cut-off of ≤1700 cells/μl was the best predictor of CD4 count <200 cells/μl. This study demonstrates the ability of TLC, whether used as a continuous or dichotomous data, to predict CD4 count or a CD4 count <200 cells/μl, respectively.

Screening of kidney disease in HIV infected hospitalised patients

Objectives: To study the renal disease in newly diagnosed HIV infected hospitalized patients and to look for possible correlation of CD4 count with prevalence of renal disease. Materials and Methods: The prospective study was conducted in Department of Medicine/Endocrinology in tertiary care health center in western U.P during the study period of one year. The patients were evaluated clinically and biochemically after obtaining the informed consent. Result: The study was conducted on 100 HIV/AIDS patients, out of which 68 (68%) were males and 32 (32%) females with a Highest incidence of HIV/AIDS (51%) in the age group of 25-35 years. Microalbuminuria was present in 20 (20%) HIV patients with majority (60%) being in the age group 25-35 years. Prevalence of microalbuminuria among males was 55% and among females 45%. Microalbuminuria was further evaluated by calculating the ratio of microalbumin to urinary creatinine, 83% patient had ratio &gt;10 mg/mmol and 17% had this ratio &lt;10 mg/mmol. The ratio of microalbumin to urinary creatinine &gt;10 mg/mmol was 60% in age 25-35 year, 25% in the age group of 36-45 year followed by 15% in the age group of 45-55 year patients. Chi-square test was used to calculate the significance of the correlation between CD4 counts with the presence of microalbuminuria in HIV patients. There was a significant correlation between CD4 count &lt;200/μL and presence of microalbuminuria (p =0006). Statistically significant proteinuria (30-300 mg/24 hour) was found in 15 patients with CD4 count &lt;200/μL of those patients found positive for microalbuminuria. Protein/ creatinine ratio was &lt;0.2 in 18 patients, 2 had ratio in the range of 0.2-3.5 and none in the nephrotic range (&gt;3.5). Conclusion: Study evaluation shows that there is statistically significant microalbuminuria in HIV/AIDS infected patients and this is more prevalent in patients with CD4 count &lt;200/μL as compared to patients with CD4 count &gt;200/μL in keeping with previous studies. The routine laboratory measurements like serum creatinine and proteinuria fail to recognize the patients with early renal involvement. In view of the high prevalence of renal dysfunction among hospitalized HIV infected patients, it is recommended to use microalbuminuria as routine screening tests in those who are HIV positive. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11376 Asian Journal of Medical Sciences Vol.6(3) 2015 58-62

Baseline antibody titres against Salmonella typhi in apparently asymptomatic HIV positive individuals in a tertiary care hospital

Enteric fever is common in tropical regions and is caused by Salmonella enterica serotype typhi (S typhi ). For diagnosis of enteric fever, the Widal test is the most widely used test after blood culture. In HIV infected individuals false positive and false negative Widal reactions are common. The result is variable titres and baseline titres that are unusual in this patient population. This study was done to determine the baseline antibody titres for S typhi among HIV infected individuals. Average baseline antibody titres against O and H antigens of S typhi were measured by standard Widal test in 200 HIV positive asymptomatic individuals, as well as 200 age and sex-matched controls. The results were compiled and statistically analysed. A total of 84 (42%) of the cases had an H antibody titre of >1:20 and 105 (52.5%) had a titre of >1:20 against O antigen. This implies that positive titre of H and O antigen is significantly associated with HIV positive cases with P<0.001. Correlation of CD4 count with antibody titres shows that there is no significant association between CD4 counts and antibody titres against either H (P=0.634) or O antigen (P=0.765). This study shows that HIV infected individuals had increased titres of antibodies against S typhi from the baseline. This indicates a need for evaluation of current cut-off values of diagnostic titres for this group. We also suggest that it is best to perform baseline titres against S t yphi for each patient at the time of diagnosis of HIV status, and to use this for future reference.

Intestinal microsporidiosis in India: A two year study

Intestinal parasitic pathogens in HIV/AIDS patients include Cryptosporidium sp, Cystoisospora sp, microsporidia and less commonly other parasites. The two most common microsporidia causing intestinal infection are Enterocytozoon bieneusi and Encephalitozoon intestinalis. Most of the Indian studies for intestinal parasitic infections in HIV/AIDS patients have not included microsporidia, due to difficult staining and identification of the parasite. The aim of the present study was to find the prevalence of intestinal microsporidiosis and their species identification along with correlation of CD4 count with parasite positivity and diarrhoea in HIV positive individuals. Stool samples of 363 individuals including 125 HIV seropositive patients with diarrhoea, 158 HIV seropositive patients without diarrhoea, 55 HIV seronegative patients with diarrhoea and 25 healthy controls were obtained from various out-patient departments and in-patients admitted to a tertiary care hospital from August 2008 to October 2009. The stool samples were subjected to examination by wet mount, modified acid fast stain for coccidian parasites and multiplex nested PCR for microsporidia. The overall prevalence of all intestinal parasites among HIV patients in our study was 26.5%. The prevalence of intestinal parasitic pathogens in HIV positive patients with diarrhoea was 43.2%. Microsporidia were the most common parasites detected (14%) in all patients, while in HIV infected patients 15.9% patients had microsporidia infection. The most common species causing intestinal microsporidiosis in our study was E. intestinalis (10.5%). In HIV seropositive individuals with diarrhoea, E. intestinalis was 20.8% and E. bieneusi 8.0% while in HIV-seropositive individuals without diarrhoea, E. intestinalis was 3.8% and E. bieneusi 1.9%. E. intestinalis was present in 10.9% of HIV negative individuals with diarrhoea in whom E. bieneusi was not found. There was a significant association between CD4 count ≤200/μl and intestinal parasite positivity. Thus, it can be concluded that intestinal microsporidiosis is under reported but an important disease in India. The predominant species in our study is E. intestinalis , in contrast to other parts of the world where E. bieneusi is more common.

Correlation of CD4 Count with Dental caries in HIV Seropositive Individuals with and without ART (Anti Retroviral Therapy)

Introduction: HIV is a retroviral disease caused by Human immunodeficiency virus (HIV), and is characterized by profound immunosuppression leading to opportunistic secondary neoplasms and neurological manifestations. These viruses store their genetic information as RNA, which is converted in to DNA by a special enzyme Reverse Transcriptase (RT). Aim: The aim of the study was to correlate the CD4 count and Dental caries activity in HIV seropositive individuals, with and without Anti Retroviral Therapy (ART). Materials and methods: Subjects above the age of 20 years who were HIV seropositive were included in this study. 112 subjects were enrolled in this study, 55 subjects were under Anti Retro viral Therapy and 57 subjects were not under Anti retroviral Therapy. A structured profoma was used to collect the data. The first part consisted of variables such as age, educational status, and use of ART, etc. The second part of the profoma consists of Dynamical Mean Field Theory (DMFT) index by WHO and CD4 count. The data was entered in excel sheet. The data was analysed by using SPSS (Statistical Package for Social Sciences). Results: In this study 41% of the subjects were within the age group of 31-40 years. 30% of the subjects had finished high school, and only 7% of the subjects were graduates. Among the study subjects who were under ART (Anti Retroviral Therapy), 7% were under Anti Retroviral Therapy for more than 5 years, 40% were within a year to 5 years, and only 7% were with a span of a year. The dental caries increases as the immune system is affected by HIV. There is a need to educate dental surgeons on safe management on dental diseases in HIV Sero positive individuals. Conclusion: Patient's confidentiality and public perception of the same become very important to ensure that such patients have confidence in the dentist, and reveal HIV C and other disease status. This will also help to protect the dentists from accidental infections.

Epidemiology of Opportunistic Infections and Its Correlation With CD4 T-Lymphocyte Counts and Plasma Viral Load Among HIV-Positive Patients at a Tertiary Care Hospital in India

The study was conducted to find the correlation of CD4 counts and plasma viral load (PVL) with opportunistic infections (OIs) in HIV-positive patients. A total of 43 drug-naive patients enrolled in the study. Absolute CD4 counts and PVL were measured. On the basis of symptoms, sputum, stool, and blood samples were obtained for laboratory tests. Oral swabs were obtained from all the patients. Pneumocystis jiroveci pneumonia was found in 45.2% patients (odds ratio [OR] = 12.8 for CD4 counts <or=100 cells/ mm(3) and 8.5 for PVL >4.0 log(10) copies/mL). Pulmonary tuberculosis (TB; OR = 8.0 for PVL >4.0 log(10) copies/mL) and streptococcal pneumonia (detected only with CD4 counts <50 cells/mm( 3) and PVL >4.0 log(10) copies/mL) were seen in 41.9% and 12.9% patients, respectively. Among patients with diarrhea, Giardia lamblia was detected in 31% patients (OR = 3.0 for CD4 counts <or=100 cells/mm(3) and 4.0 for PVL >4.0 log(10) copies/mL) and Cryptosporidium in 17.2% patients (OR = 1.8 for CD4 counts <or=100 cells/mm(3) and found only with PVL >4.0 log(10) copies/mL). Shigellosis and Clostridium difficile toxin was present in 13.6% patients and 6.8% patients, respectively.

Surrogate end points and their role in clinical trials: Reply from authors

Sir, We agree that surrogate markers should meet the requirements of easy availability and affordability, and that the end points should be reliable, exhibit a dose response effect, and be quantifiable and reproducible.[1] It was precisely for this reason that in our study,[2] CD4 was used as a marker, which is universally accepted, claimed to be reliable, a true predictor, specific and sensitive for predicting the outcome and progression of HIV infection. The CD4 count is also used to assess therapeutic efficacy. However, it has no precise cut off point. Since it has not been documented whether the immunity offered by tinospora is cell mediated or humoral, other in vitro methods were not used by us. Hence, we complemented our study with clinical monitoring as well, for the evaluation of the therapeutic effect of tinospora. The other specific marker used in measuring the therapeutic effect in HIV positive patients is the viral load. However, as quoted in the first point by the learned author, this was not available in our institution at the time this study was commissioned and due to financial constraints, it could not be procured from elsewhere. Our study was not industry sponsored and was funded by an NGO, without any conflict of interest. In a research protocol, a hypothesis is formulated and after approval by the EC (Ethical Committee), the application for grant is made. At the planning stage, we expected that CD4 count may give us some correlation with therapeutic effect; however, at the end of study, on evaluation, it was not found to be so. It may be appreciated that our findings truthfully report the poor correlation of CD4 count with clinical findings with six months' use of Tinospora cordifolia extract in human immuno deficiency virus positive patients.

Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations

The relationship between oral lesions arising from HIV infection and CD4/CD8 cell ratios is of relevance in clinical assessment of immune suppression. To correlate the prevalence of oral manifestations arising from HIV infection and the levels of CD4/CD8 cell ratios. A cross-sectional study. Kenyatta National Hospital, Nairobi, Kenya. Two hundred and seven HIV-infected patients in medical wards were recruited in the study. Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-73 years (mean=34.81 years). Oral manifestations encountered with highest prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa) 15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes simplex (corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa) 0.5%, Parotid enlargement 2% and Kaposis sarcoma (hard/soft palate) 2.9%. The prevalence of oral manifestations was higher with low CD4 count <200 cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48).

Correlation of CD4 count, CD4% and HIV viral load with clinical manifestations of HIV in infected Indian children

To correlate the absolute CD4 count, CD4% and HIV viral load with different clinical manifestations of HIV in antiretroviral-naive children. The paediatric and perinatal HIV clinic in a tertiary care hospital over a period of 4 years, from January 1999 to December 2003. A total of 92 highly active antiretroviral-naive, HIV-1-infected children were enrolled in a cross-sectional study. The clinical manifestations, age, sex and CDC classification of each patient were determined. CD4 count, CD4% and HIV-1 viral load were estimated at presentation and correlated with various clinical manifestations of HIV disease. CD4% was higher in infants (p < 0.001) and lower in children over 5 years of age (p = 0.01). Boys had a higher absolute CD4 count than girls (769 +/- 517 vs 532 +/- 430 cells/mm3, p = 0.02). Patients with lymphadenopathy (n = 43) had a high CD4 count (840 +/- 487 cells/mm3, p = 0.01) whereas patients with HIV cardiomyopathy (n = 4) had low CD4 counts (mean 182 cells/mm3, p = 0.04). In patients with failure to thrive (n = 29), the CD4% was low (14 +/- 9%, p = 0.02) and HIV-1 viral load was high (mean 4.5 x 10(5) copies/ml, p = 0.03). CD4 count, CD4% and HIV viral load did not correlate with the stage of the disease as per the CDC classification. HIV viral load, CD4 cell count and CD4% vary with age and disease complications in HIV-infected children. However, CD4 count, CD4% and viral load did not correlate with CDC classification.

Neopterin and other indicators of HIV progression in Zambian adults

Abstract In this study, we assessed a possible correlation of CD4 counts with the low-cost progression markers neopterin, 132-microglobulin (B2M), total lymphocyte count (TLC) and hemoglobin, and we investigated associations between progression :narkers and clinical parameters in HIV -1 seropositive Zambians. Of 147 HIV- 1 seropositive patients presenting to an outpatient clinic in Lusaka, blood was taken for CD4 counts, serum progression markers and full blood count. A detailed clinical history and medical examination was taken at that point, and the patients were seen 3··monthly over the following 12 months. Further CD4 counts were taken after 6 and 12 months. Neopterin, B2M: lymphocyte count, and hemoglobin showed a strong correlation with CD4 count. Of the serum progression markers, neopterin was more sensitive than B2M to detect HIV related symptoms and to predict weight loss and death in the follow-up period. Lymphocyte count and hemoglobin were significantly lower in patients with oral candidiasis and those falling sick or dying in the follow-up period. Hemoglobin was also associated with past diarrhoea. When stratified by sex, the associations of hemoglobin were very strong in males, but weaker in females . In conclusion, neopterin and B2M correlate well with CD 4 counts in this African population. Neopterin appears to be more sensitive for the clinical evaluation o: the patients in this study. Hemoglobin might only be useful as a progression marker in male individuals .